1053416305 NPI number — RESHMA BANERJEE-KATARIA DO

Table of content: RESHMA BANERJEE-KATARIA DO (NPI 1053416305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053416305 NPI number — RESHMA BANERJEE-KATARIA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANERJEE-KATARIA
Provider First Name:
RESHMA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053416305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/28/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 428
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEELERSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45694-0428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-355-8562
Provider Business Mailing Address Fax Number:
740-355-7149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8101 HAYPORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHEELERSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45694-1769
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-355-8562
Provider Business Practice Location Address Fax Number:
740-355-7149
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  34008464 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2548881 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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